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OVERVIEW

image SUMMARY

  • Cryosurgery is an effective method for treating selected basal cell carcinomas and squamous cell carcinomas. It yields high cure rates and can be performed in the office. It is also suitable for most patients, and its complications are low.

image DON’T FORGET

  • A temperature range of −50°C to −60°C is necessary to destroy cancer.

  • Indications and contraindications should be reviewed with the patient before treatment.

image CLINICAL PEARLS

  • Attention must be paid to the lateral spread of freeze and clinical freezing to achieve the necessary temperature for the destruction of cancer.

  • A double freeze-thaw cycle is recommended to ensure lethality.

  • Curettage prior to starting freezing is often performed.

  • Segmental treatments can be done for larger tumors.

image PATIENT EDUCATION POINTS

  • Patients should be educated on the expected duration of time for secondary healing.

  • Patients should be educated in advance on the early exudative phase after treatment, which requires frequent washing of the site.

  • Patients will have complete mobility of the area after treatment.

  • There is no keloid formation after treatment.

INTRODUCTION

Cryosurgery can be used either as a primary or alternate method to treat nonmelanoma skin cancers (Figure 43-1 & Figure 43-2). The term cryotherapy is sometimes used interchangeably with cryosurgery. It is frequently used by dermatologists for the treatment of benign lesions, to one degree or another, but it is also useful for the eradication of selected basal and squamous cell carcinomas.1-5

Figure 43-1

Basal cell carcinoma on the postauricular left neck of a 78-year-old woman.

Figure 43-2

Basal cell carcinoma on the back of an 82-year-old woman.

The objective is to cause selective necrosis of tissue. Rapid heat transfer occurs as a result of the difference between the skin temperature and that of the cryogenic substance, liquid nitrogen (−196°C, boiling point.) Other substances are less cold and therefore are not recommended for the treatment of skin cancer.

The apparatus for dermatologic use is a handheld unit that employs liquid nitrogen in a closed system and delivers continuous and rapid extraction of heat from tissue. The volume of liquid nitrogen, the technique of treatment, and the duration of freezing can vary depending on the type of lesion.

The most common treatment technique is open spray followed by the use of a cryoprobe (contact therapy). The former is faster and is effective for all shapes of lesions, and it is also useful for dividing treatment of large lesions into sections.2 Even though cryosurgery is a simple procedure, the operator should not perform it on skin cancer without first obtaining some knowledge of treating malignant lesions. Namely, one should understand the freezing time and method required to treat ...

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